Prescription Drug Monitoring Program (PDMP) - Electronic Health Record (EHR) Integration: Benefits and Challenges from the Nursing Informatics Perspective

Learning outcome: To examine the value of integrated PDMP data in clinical practice, relevant PDMP interoperability and data sharing challenges, and nursing informaticists’ role in supporting PDMP utilization best practices.

Prescription drug monitoring programs (PDMPs) are state-run databases that provide clinicians with patient-level prescription data for controlled substances. This information promotes the safe prescribing of controlled substances and informs clinical decision-making for patients in need of these medications. Registered users can access a state’s PDMP either by logging directly into the state PDMP website/portal or through an access point integrated within the electronic health record (EHR). Although EHR integration is more complex due to the technical interfacing required between the two software applications, it offers a seamless and user-friendly workflow that supports clinical decision-making at the point of care. The inclusion of PDMP querying in incentive programs, such as the merit-based incentive payment system (MIPS) and the promoting interoperability programs (PIP) from the Centers for Medicare & Medicaid Services (CMS), underscores the increasing emphasis of PDMP accessibility and utilization.

However, significant challenges still hinder the effective use of PDMPs, particularly in achieving seamless interoperability and consistent data sharing. Different states have varying regulations regarding which drugs must be reported. States typically require reporting of certain federally scheduled medications, and additionally some states mandate reporting for certain non-scheduled drugs of interest. Some states mandate real-time or near real-time reporting, while others allow for delayed reporting. These inconsistencies can affect the timeliness of available data, resulting in fragmented data that healthcare providers may struggle to access. Furthermore, there are variations in how states authorize clinician access to PDMPs, with some offering limited permissions and others providing broader access. This disparity can compromise the ability to perform a complete medication history review, particularly for providers treating patients across state lines. These challenges make it difficult to effectively address controlled substance misuse and highlight the need for a national PDMP framework to standardize practices and facilitate comprehensive, interoperable data sharing across the country.

Nursing informaticists play a crucial role in addressing PDMP-related issues, as these issues intersect technology, patient care, and data management. By leveraging their expertise, nursing informaticists can work for improved PDMP-EHR integration, promote user-centered design, and champion consistent data-sharing standards to enhance the functionality and utility of PDMPs within the healthcare setting. Furthermore, informaticists must educate clinical staff on accessing and utilizing PDMP data effectively as usability issues and a lack of understanding may lead to underutilization of this valuable clinical tool. Nursing informaticists can significantly influence the future of PDMP utilization by prioritizing integration and advocating for best practices.